Saretta Francesca, Giovannini Mattia, Mori Francesca, Arasi Stefania, Liotti Lucia, Pecoraro Luca, Barni Simona, Castagnoli Riccardo, Mastrorilli Carla, Caminiti Lucia, Marseglia Gian Luigi, Novembre Elio
Pediatric Department, Latisana-Palmanova Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy.
Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy.
Front Pediatr. 2021 Dec 23;9:801753. doi: 10.3389/fped.2021.801753. eCollection 2021.
The alpha-gal syndrome is an allergic syndrome that comprises two clinical pictures: an immediate hypersensitivity to drugs containing alpha-gal and a delayed hypersensitivity to the ingestion of red mammalian meat. This allergic syndrome is often under-recognized, and patients are mislabeled with diagnosis as spontaneous urticaria or idiopathic anaphylaxis. Even though less frequently, children could also be of interest, especially in tick-endemic areas. In most cases, a positive anamnesis for tick bites months before the onset of symptoms is recorded. The clinical manifestations could range from asymptomatic cases to severe anaphylaxis. The most frequently used diagnostic test is the determination of specific IgE for alpha-gal. Oral provocation test is usually reserved to unclear cases or to verify tolerance after diet. No long-term follow-up studies have been published, although an elimination diet could lead to a decrease of specific IgE for alpha-gal and a possible reintroduction of some avoided foods. This paper provides a literature review, focused on pediatric age, and an evaluation of available diagnostic tests. We analyze the correlation between tick bites and symptom onset and unfold the different clinical pictures to help clinicians to promptly recognized this syndrome. Lastly, we address unmet needs in this specific allergy.
α-半乳糖综合征是一种过敏综合征，包括两种临床表现：对含α-半乳糖的药物立即发生超敏反应，以及对摄入红色哺乳动物肉类发生迟发性超敏反应。这种过敏综合征常常未得到充分认识，患者常被误诊为自发性荨麻疹或特发性过敏反应。即使儿童病例较少见，但在蜱虫流行地区也可能出现，尤其是儿童。在大多数情况下，患者在症状出现前数月有蜱虫叮咬史。临床表现从无症状到严重过敏反应不等。最常用的诊断测试是检测α-半乳糖特异性IgE。口服激发试验通常用于诊断不明确的病例或在饮食后验证耐受性。尽管排除饮食可能会使α-半乳糖特异性IgE降低，并有可能重新引入一些避免食用的食物，但尚未发表长期随访研究。本文提供了一篇侧重于儿童年龄的文献综述，并对现有诊断测试进行了评估。我们分析了蜱虫叮咬与症状发作之间的相关性，并阐述了不同的临床表现，以帮助临床医生及时识别该综合征。最后，我们探讨了这种特定过敏领域尚未满足的需求。
